Antibody-mediated rejection in ABO compatible husband to wife living donor liver transplant and review of the literature

• Published in: Human immunology Vol. 75; no. 6; pp. 578 - 583
• Main Authors: Kheradmand, T, Anthony, T.L, Harland, R.C, Testa, G, Hart, J, Renz, J, Te, H.S, Marino, S.R
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2014
• Subjects: ABO Blood-Group System - immunology; Adult; Allergy and Immunology; Autoantibodies - blood; B-Lymphocytes - immunology; B-Lymphocytes - pathology; Complement C4b; Female; Graft Rejection - immunology; Graft Rejection - pathology; Graft Rejection - therapy; Histocompatibility Testing; HLA Antigens - immunology; Humans; Immunoglobulins, Intravenous - therapeutic use; Isoantibodies - blood; Liver Cirrhosis - immunology; Liver Cirrhosis - pathology; Liver Cirrhosis - surgery; Liver Transplantation; Living Donors; Male; Peptide Fragments - blood; Plasmapheresis; Spouses; T-Lymphocytes - immunology; T-Lymphocytes - pathology; Transaminases - blood; Transplantation, Homologous; DSAs; AST; LDLT; donor specific antibodies; total bilirubin; POD; AMR; post-operative day; aspartate aminotransaminase; ALT; IVIG; mean fluorescent intensity; deceased donor liver transplant; TB; MFI; FCXM; flow-cytometric crossmatches; antibody mediated rejection; orthotopic liver transplant; OLT; DDLT; alanine aminotransaminase; living donor liver transplant; intravenous immunoglobulin
• ISSN: 0198-8859; 1879-1166
• DOI: 10.1016/j.humimm.2014.02.010

Abstract Role of donor specific antibodies (DSAs) in liver allograft function has not been fully defined. We report an ABO compatible orthotopic liver transplant case with DSAs to donor HLA, where the patient developed immediate antibody-mediated rejection (AMR).The patient, a 43-year-old female with cirrhosis, underwent ABO-compatible living-donor liver transplant from her husband. On post-operative day (POD)1, serum transaminases were sharply elevated. Retrospective testing of pre-transplant serum demonstrated presence of strong class I and class II anti-HLA antibodies and positive T- and B-cell flow-cytometric crossmatches (FCXM). Transaminase levels improved with plasmapheresis and thymoglobulin. On POD7, her liver enzymes became elevated again and allograft biopsy stained positive for C4d. Patient was treated with intravenous immunoglobulin and rituximab and recovered over time. Pre-transplant sera of patient were retrospectively tested by C1q assay to determine the cytotoxic function of DSAs; DSAs were positive for C1q binding. Our results suggest that pre-liver transplant antibody testing may be helpful in identifying patients at risk for development of AMR.